During the past twenty years, the goals of improved cost recovery and sustainability of primary health care have been emphasized in many health programs in Africa, e.g., the Bamako Initiative. In DR Congo, a 1986 survey was calculated that more than 90% of the functioning costs of primary health care at the health center level were supported by cost recovery.

However, as many Africans became economically poorer in recent years, and as crisis situations developed in various areas, relief organizations providing emergency health care have been more reluctant to pursue these goals. With some groups, the goals of cost recovery are even seen as an unjust exploitation of the poor.

In the Democratic Republic of Congo, where the people are some of the poorest in the world, there is a movement to minimize cost recovery in favor of an externally subsidized system. But there are many lessons learned during these hard times that indicate that cost recovery can be appropriate and effective even in some of the direst situations.

The key is to base the system on cost reduction and increased efficiency and not on increased income. This presentation will provide examples of how this has been, and still is being done, in a number of health zones throughout DR Congo.

Learning Objectives: At the conclusion of the session, the participants will be able to

Define cost recovery in the context of the DR Congo health system

List several reasons for continuing limited cost recovery as part of primary health care in DR Congo.

Presenting author's disclosure statement:I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.